Managed Care

 

ICD-10 — Rough Transition

ICD-10 — Rough Transition

Randy Vogenberg, PhD, RPh

Although the results overall are not too surprising, after two rounds of end-to-end ICD-10 testing, the results at the North Carolina Healthcare Information and Communications Alliance are “scary,” executive director Holt Anderson told the Medical Group Management Association annual conference last week.

For 20 dual-coded and peer reviewed scenarios, results from the first test were 55 percent accurate, reported Government Health IT. That rate improved to a 63 percent accuracy rate in the second round. But worker productivity dropped by 50 percent — to an average of two medical records per hour with ICD-10 compared to four or more under ICD-9.

“We selected some of the best of the best coders in these organizations,” he said. Then, through peer review, the researchers realized that these coders weren’t coding correctly in ICD-9, let alone ICD-10.

This can have big implications for hospitals and their health systems for both staffing and revenue.  As one example, the use of new or existing higher cost drugs and specialty drug starts could be impacted because of coding problems resulting in under- or over-billed revenue issues for the care delivery entity.

For health plans or employers, medical claim errors, increased coding problems, and payment discrepancies will foster greater inefficiencies in plan administration along with potential problems with care networks in the form of  delayed payment or audits.

Randy Vogenberg, PhD, RPh
Principal, Institute for Integrated Healthcare

Meetings

2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
6th Semi-Annual Diagnostic Coverage and Reimbursement Conference Boston December 4–5, 2014
Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
9th Semi-Annual Medical Device Coverage and Reimbursement Conference San Diego December 5, 2014
8th Annual Medical Device Clinical Trials Conference Chicago December 8–9, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015